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eBOOK : Cardiovascular Disease in the Elderly Patient Second Edition, Revised and Expanded

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It is not difficult to understand the often held misconception that heart disease is part of ‘‘normal aging’’ and that overall cardiovascular function declines with increasing age. This rapidly growing portion of the population often does have heart disease, with hypertension, coronary artery disease, and heart failure being three conditions commonly diagnosed in many elderly patients. Nonetheless, it is not the case that heart disease and impaired cardiac function is a sine que non of the aging process. Healthy elderly persons have normal left ventricular systolic function at rest. Importantly, there are certain cardiovascular changes that occur with aging throughout the animal kingdom which are important to recognize and which are described below. Knowledge of the cardiovascular changes that occur with aging are important for several reasons. First, recognition of these changes allows us to better distinguish normal cardiovascular aging from disease states in the elderly. Second, manifestations of various cardiovascular diseases vary between young and old patients, most likely influenced in part by changes that occur with aging. An example is hypertension, which is manifest as diastolic blood pressure elevation in younger subjects and systolic blood pressure elevation in the elderly. Third, the ability of an individual to compensate for their cardiovascular illness may be age-dependent, and thus the elderly patient may be more symptomatic for any burden of disease and require more aggressive evaluation and therapy than younger subjects. An example includes congestive heart failure, which is one of the most common discharge diagnoses in the Medicare population (1). Fourth, the response to appropriate cardiovascular therapy may also be somewhat age-dependent, such as β-adrenergic receptor blockade. Finally, there have not always been clear distinctions between when an age-related phenomenon becomes a disease-
related phenomenon. An example includes the increase in left ventricular mass that occurs with increasing age in disease-free subjects and the known fact that increasing left ventricular mass predicts future cardiovascular morbidity and mortality (2,3). In the sections below, animal and human studies will describe resting cardiovascular function, the response to stress, and ventricular–vascular coupling.

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